Summary Service Mdel Crisis respite facility and hme based 2014
Table f Cntents Purpse... 3 Prgramme Cntext... 3 Prgramme Descriptin... 3 Service Aims... 4 Service Cntext... 4 Recvery Philsphy... 5 Target Grup... 5 Access & entry... 6 Assessment... 6 Key service elements and interventins... 7 Exit... 8 Service utcmes... 9 Staffing... 9 Staffing prfile... 9 Mnitring & gvernance... 10 Measures f Success: (link t service utcmes)... 10 Data cllectin:... 10 Prgramme gvernance:... 10 Page 2 f 10
Purpse This dcument cncisely describes the bjectives, scpe, service delivery practices and facilities invlved in prviding Australian Gvernment funded early interventin mental health crisis respite services (bth facility based and hme based) fr Suth Australia. This descriptin f the mdel f service delivery will prvide a cnsistent practical and authritative reference fr all prviders f this service. It is als intended t prvide guidance fr SA Health in cnsidering prgram resurcing, evaluatin and accuntability arrangements. This dcument is intended t be accmpanied by a set f peratinal guidelines. Prgramme Cntext Recent Gvernment plicy initiatives, prviding clear cmmitments t delivering apprpriate, high quality and equitable services fr peple with a mental illness include: the Stepped System f Care endrsed by the State Gvernment, February 2007 Natinal Actin Plan n Mental Health 2006-2011; Natinal Mental Health Plan 2009-2014; COAG plan fr mental health The Australian Gvernment alng with the State and Territry Gvernments has recgnised the need fr grwth in the mental health sub-acute sectr, prviding an increase in ut f hspital service ptins fr peple with mental health issues. Under the Natinal Partnerships Agreement n imprving public hspital services, SA received funding fr bth bed based and hme based early interventin fr peple with mental health issues presenting in crisis. This dcument describes the mdel f service fr bth facility based and hme based services. Prgramme Descriptin Sub-acute crisis respite is a service apprach fr peple with mental health issues wh are in crisis and where their mental health may be cmprmised r at risk, but wh d nt require intensive clinical interventins r admissin t an acute mental health facility. The differentiating feature f this mdel f sub-acute crisis respite frm ther mental health services within the cntinuum f care is the fcus n the delivery f care that encmpasses bth nn-gvernment and public mental health service input fr individuals wh are in need f respite, encmpassing largely psych-scial interventins and supprt. Interventins are targeted tward addressing the issues which may have led t presentatin in crisis, and returning the individual t their usual residence with increased supprt, r changes t circumstances which may have precipitated the crisis. Service delivery is based arund respite beds r supprt in hme r anther apprpriate living envirnment (e.g. a shelter) prvided by bth the gvernment and nn-gvernment mental health services. Sub-acute crisis respite is staffed ver 24 hurs and includes bth clinical and supprt staffing. The service will be ffered in the hme r a hmelike envirnment. Page 3 f 10
Service Aims T prvide hme r bed-based respite fr individuals presenting in crisis with issues largely scial in nature, and requiring predminantly scial and psychlgical interventins. T prvide apprpriate and timely ut f hspital care fr peple experiencing a mental health crisis. Respite will aim t imprve mental health utcmes, stp deteriratin in mental health, and/r restre the individual t usual r imprved functining. Respite aims t prvide an alternative t hspitalisatin r emergency department presentatin in a mre apprpriate envirnment. A therapeutic envirnment will be prvided. Interventins are prvided up t 7 days (extensin can be negtiated n the basis f acceptable ratinale). T minimise mental health hspital admissins resulting frm crisis. Decreased wait and stay times in emergency departments. T prvide a timely respnse t referrals frm mental health triage, emergency departments, cmmunity mental health services taking int accunt cnsumer, carer and mental health system cntext. Service delivery will be reviewed and mnitred within a clearly articulated evaluatin framewrk. Service Cntext The crisis respite service is a cmpnent f an integrated system f mental health care. The service is integrally linked with adult cmmunity mental health integrated teams, with mental health triage, and with emergency departments. Crisis respite is a sub-acute service, with a fcus n respnding t scial and psychlgical crisis presentatins. In the stepped mdel f care, Crisis respite fits alngside and cmplementary t intermediate care. Page 4 f 10
Recvery Philsphy All services prvided thrugh Crisis Respite will have a recvery fcus and wrk clsely with cnsumers carers/families t ensure that care prvided is aligned with ther services in the cntinuum prvided thrugh mental health and nn-gvernment services. The principle f care ffered in the least restrictive envirnment will underpin discussin with cnsumers abut crisis respite service ptins. Where pssible, clients shuld receive services clse t r within their lcal cmmunity t facilitate their reintegratin int scial and cmmunity netwrks. Target Grup Services will wrk t identify peple wh are best fit fr the crisis respite prgramme using the fllwing criteria: Aged between 18 65. Peple wh are yunger r lder will be accepted if develpmentally apprpriate and suitable fr the envirnment and service. Individuals wh are experiencing disruptin t usual mental health and require a shrt term crisis respite respnse which may be due t ne r a cmbinatin f the fllwing r ther reasns: Existence f a high prevalence disrder where acute admissin is nt indicated, and assessed level f risk can be managed in the envirnment. Carer whse stress levels have precipitated mental health issues. Family and/r relatinship issues (usual supprts under stress). Accmmdatin stress. Substance misuse which is impacting n mental health and ability t functin but where clinical respnse is nt required. Financial issues which impact n usual living situatin (e.g. unpaid electricity bill, rent mney etc.). Lss and grief issues. Physical health issues which impact n usual mental health and/r have prmpted a crisis presentatin and which can be managed within the crisis respite envirnment. Entry t the crisis respite service is a pssible alternative t an emergency department presentatin r an acute admissin. Referrals must have an element f hspital avidance. Engagement in the Crisis respite service is vluntary. Catchment fr each crisis respite facility will be based n surce f referral as well as residence. The three facilities will wrk clsely tgether t ffer a place if the service is deemed apprpriate. Equal cnsideratin will be given t individuals frm cuntry lcatins, particularly thse wh have presented t a metr emergency department, r where a respite stay is mst apprpriate and least restrictive ptin fr care. * Hmelessness is nt an exclusin fr this service. * Scheduled r planned respite is nt in scpe fr this service. Page 5 f 10
Access & entry Individuals will be referred t crisis respite thrugh adult public mental health services and assessment fr suitability fr crisis respite service will be undertaken by designated clinicians attached t crisis respite, r by clinicians perfrming an acute functin within metr adult integrated cmmunity mental health teams in cnjunctin with cnsumer, carer and ther service prviders. As part f this prcess, cnsideratin will be given t the suitability f facility based r hme based crisis respite service. The crisis respite service will accept referrals acrss 24 hurs. Entry will be determined by mental health services. External service prviders such as GPs and NGOs wh identify individuals ptentially suitable fr the service will need t wrk with integrated teams t access. Referrals frm cuntry and yuth services will be made thrugh metrplitan health service integrated teams. It is expected that a clinical assessment will be undertaken by referring services. Bed flw fr Crisis respite service is managed thrugh designated prcesses in the cmmunity mental health integrated teams in cllabratin with the nn-gvernment service prvider. This includes access t and frm bth facility and hme based crisis respite. Individuals may mve directly frm cmmunity mental health r frm an emergency department int crisis respite as per agreed pathways. Access fr cuntry lcated cnsumers will be cnsidered n a needs basis (as abve). They will nt be excluded n the basis f address. Transprt t and frm the facility is primarily the respnsibility f the individual being referred in cnsultatin with the referring clinician; hwever the crisis respite service will act t expedite transfer t a facility r hme as apprpriate. Individuals already receiving a cmmunity mental health service frm a care crdinatr shuld be cnsidered fr access as sn as the need fr crisis respite is identified. Access pathway will be fllwed, but replicatin f assessment is nt required. This is nt an indicatin f pririty access, rather minimising duplicatin in terms f assessment and dcumentatin. Respite shuld be linked t existing management plans where pssible and duplicatin f assessment and dcumentatin shuld be minimised. Cnsideratin will be given t cultural needs including thse frm Abriginal and/r ther culturally and linguistically diverse backgrunds. Assessment Clinical assessment, including risk assessment will be undertaken/updated prir t entry int crisis respite. The referring service will identify reasns fr entry int the respite service. Medical invlvement in assessment will be prvided thrugh the mental health service as required. Cnsideratin shuld als be given t issues relating t substance use and general health presentatin. Up t date clinical and scial infrmatin shuld be surced, including cllateral infrmatin and views frm families and carers where pssible. Infrmatin shuld als be sught frm supprting agencies and general practitiners wh are invlved. Page 6 f 10
An assessment f need shuld be undertaken by the NGO service prvider using a recgnised assessment frmat r tl (e.g. Camberwell assessment f need). The level f individual risk must be assessed as being able t be managed within this service and envirnment. This includes risk t self, thers, and risk t general health. Assessment will include a recmmendatin f individual suitability fr the facility based r hme based service. This is cvered in mre detail in the peratinal guidelines. Key service elements and interventins The service will be perated 24 hurs/7 days per week by the nn-gvernment sectr wrking in frmal partnership with mental health service staff and ffering bth bed based crisis respite and hme based crisis respite. The service will perate frm a recvery based philsphy, and aim t identify and address the issues integral t the develpment f the crisis. Length f service will be up t 7 days. If a lnger service is required, it will be negtiated with the individual, carer/families and ther relevant service prviders based n nging need fr crisis respite service. The hme based cmpnent f the crisis respite service culd be prvided in an alternative envirnment t an individual s usual hme. Examples f this may be the hme f a relative r friend, a dmestic vilence shelter. Any hme r alternative t hme envirnment shuld be cnsidered carefully fr its capacity t prvide an apprpriate envirnment fr crisis respite. Individuals will wrk with a nminated wrker frm the respite service during their time with the service and clse wrking partnerships will be develped and enhanced with cmmunity mental health teams and ther relevant individuals and agencies relating t the individual s needs. A clse wrking relatinship between staff and cnsumers will identify hw the respite service can be utilised. It is inherent in this mdel that all interventins and elements are negtiated and undertaken with cnsumers and carers. Individuals in respite will be able t access assistance apprpriate t their particular need (e.g. any member f the crisis respite service - NGO r mental health service staff, and/r linking with relevant agencies and service prviders such as general practitiners). Cmputer and internet access fr cnsumers is an integral part f supprting recvery and self-management. Residents will be expected t participate in the daily life f the crisis respite facility r hme by engaging in shpping, cking and cleaning in a cperative fashin as able. Residents will bring any medicatin and prescriptins int the crisis respite service with them. They will be expected t purchase and cntinue medicatin as usually prescribed. Existing relatinships with general practitiners will be maintained and enhanced where pssible, cnsumers withut a nminated GP will be encuraged t identify a practice and visit a GP. Page 7 f 10
Cnsistent dcumentatin will be used acrss the three services. Service elements which may be delivered by crisis respite staff r by referral t ther agencies/wrkers as part f crisis respite are listed belw. The shrt term nature f the crisis respite service needs t be taken int accunt when cnsidering where interventins will be best delivered and by whm. Elements may include: Identificatin/re-establishment f key scial and cmmunity relatinships and supprts. Reviewing and strengthening relatinships with GP. Strengthening skills fr living, including future supprt pathways. Identificatin f stressrs and stress management techniques. Identificatin f any substance use issues with referral n as apprpriate. Identificatin f issues with physical health with referral n as apprpriate. Carer supprt. Educatin regarding mental health, mental illness, rle f clinical interventins. Advcacy. Clinical risk assessment & risk management. Diagnstic clarificatin. Assessment f current accmmdatin identificatin f strengths and issues. Assistance with finance and husehld management. Lss & grief cunselling. The nature f the crisis respite service will be cnsistent acrss the 3 services, althugh there may be sme lcal variatin. Individuals are encuraged t cntinue invlvement with: existing clinical interventins and treatments. existing activities and supprts as aligned with the need fr crisis respite. The facility based service cmpnent will prvide an envirnment that is welcming, calm, safe and private which supprts crisis respite, while als supprting transitin t an apprpriate lcatin n exit. Exit Planning fr service exit will cmmence at entry. Individuals will be linked back with their usual supprts as far as pssible, and every attempt shuld be made t ensure that accmmdatin n exit is safe and secure. Cntact will be made with family and/r carers and ther service prviders prir t the individual leaving a facility and a planning meeting will be undertaken. A summary f stay will be prvided t the cnsumer, carer and relevant service prviders as apprpriate. This will include clarity regarding medicatin prescriptin and prvisin, and a plan fr individual respnse t crises. An updated clinical assessment, including risk assessment will be undertaken by mental health services staff prir t leaving, with subsequent plan and actins as required. Page 8 f 10
In the event f individual behaviurs which impact in an adverse way n the individual r ther service users, cntingency plans fr timely and safe exit will be develped. Service utcmes May include the fllwing: Crisis mdificatin and/r reslutin. Change r imprvement in usual circumstance, including accmmdatin. Imprvement in mental health/symptm reductin. Restratin f integrity f usual supprt netwrks. Plan fr next steps and supprts fr successful cmmunity living. Reductin in individual presentatin t emergency departments. Staffing Staffing prfile The facility will be staffed by a nn-gvernment rganisatin using supprt wrkers, and with a team leader n site. Cnsideratin shuld be given by the NGO t the emplyment f an enrlled nurse t assist with physical health matters, and t the emplyment f sme staff with lived experience f mental health issues. The NGO will als wrk cllabratively with mental health services t prvide utreach frm the facility t supprt hme based crisis respite. MHS will emply RN2/AHP2 staff within a nminated integrated team in the same sectr as the facility t wrk with the nn-gvernment rganisatin t ffer bth facility based and hme based crisis respite. Mental health services will ensure a mix acrss teams and areas between nursing and allied health staff and cnsideratin shuld be given t emplying staff members with expertise in wrking with peple with substance use issues. Mental health services will emply a RN2/AHP2 in cuntry MH t assist in access, entry and exit frm the three Crisis respite facilities. This psitin will be lcated where sufficient liaisn can ccur with metrplitan emergency departments, rural & remte inpatient unit, and emergency triage and liaisn services (ETLS). It is envisaged that this psitin will wrk as part f the crisis respite service and be part f prgramme gvernance arrangements. Page 9 f 10
Mnitring & gvernance Measures f Success: (link t service utcmes) Individual satisfactin arund reslutin f situatin leading t crisis respnse service. Demnstrated imprvements in individual satisfactin arund areas such as quality f life, hpe fr the future, and belief in their ptential t recver and regain meaningful life rles. Imprvement in mental health. Increased stability f cmmunity tenure. Increased family satisfactin. Decreased psychscial related hspitalisatins. Decreased number f emergency department presentatins. Exit plan in place and fllwed thrugh in cntact within 7 days f exit. Data cllectin: Referral surces Reasn fr referral (primary). Occupancy & separatins. Length f stay (LOS). Exit date. Time frm referral t entry. K10. Cmpliments/cmplaints. Adverse events. Evidence f exit planning. Discharge destinatin. Admissin t acute rates. Other infrmatin as may be specified in a service prvider cntract. Prgramme gvernance: Crisis respite service will be verseen by a prgramme management cmmittee (PMC) which may include representatives frm the Department f Health, reginal mental health services, NGO service prviders, cnsumer and carers. The cmmittee will versee the prgramme with respect t implementatin, prgramme fidelity and prgramme evaluatin, as well as develping and mnitring prgramme partnerships. Gvernance f service delivery is further utlined in peratinal guidelines. Page 10 f 10